| BackgroundTotal knee arthroplasty(TKA)is the main method for the treatment of severe knee osteoarthritis,which can significantly relieve the pain of the knee joint,restore the lower limb line structure and knee joint range of motion,and greatly improve the quality of life of patients.Angle after tibial platform(PTS)of knee joint replacement surgery is one of the important parameters of lateral line of tibia bone cutting,determines the recovery of the patients with lower limb power line,as well as the force transmission direction,inaccurate tibial side cut lines can lead to lower limb force compared with preoperative adverse,knee flexion gap imbalance,thus secondary knee prosthesis loosening,affect the knee joint function recovery,And then affect patient satisfaction.However,there is no uniform standard for the selection of posterior Angle of tibial plateau.ObjectiveThe purpose of this study was to compare the efficacy of anatomic and fixed oblique osteotomy in total knee arthroplasty in order to find a more suitable posterior Angle osteotomy of tibial plateau for total knee arthroplasty.MethodsSixty patients admitted to our hospital from January 2020 to June 2021 for knee osteoarthritis and undergoing unilateral TKA surgery were selected.The patients were divided into anatomic group and fixed group according to the different plans determined by the intraoperative PTS.Among them,30 patients in the anatomic group underwent osteotomy according to the anatomic posterior Angle of the proximal tibia measured before surgery.In the fixation group,30 patients underwent 3° retrograde osteotomy for proximal tibia fixation.Both posterior cruciate-substituting(PS)implants were used.The posterior inclination of tibial plateau,knee range of motion(ROM),knee flexion and extension stability before and after surgery were compared with the Hospital for Special Surgery of New York(HSS)score to measure knee functional recovery and postoperative patient satisfaction score SF-36.After comprehensive evaluation of the postoperative effects of the two osteotomy programs,the conclusion is drawn.ResultsPosterior tibial slope angle: The posterior inclination of tibial plateau was(10.56±1.42)° in the postoperative anatomical group and(3.38±0.23)° in the fixed group,and the difference between the two groups was statistically significant(P < 0.01).Knee flexion range of motion: The maximum knee flexion Angle of both groups was significantly higher than that of the preoperative period.Two weeks after surgery,the maximum knee flexion Angle of the anatomical group(92.47±3.28)°was close to that of the fixed group(93.00±3.39)°,and the difference was not statistically significant(P=0.538).6 weeks after surgery,the anatomical group(110.97±5.19)° and the fixed group(106.93±4.80)°,3 months after surgery,the anatomical group(124.77±5.28)° and the fixed group(121.43±7.15)°,6 months after surgery,The anatomical group(127.90±5.84)°and the fixed group(123.30±6.02)°,and the anatomical group(129.43±5.71)°and the fixed group(124.57±6.49)° one year after surgery,the above data showed that the maximum knee flexion Angle of the anatomical group was significantly improved compared with the fixed group,the difference was statistically significant(P <0.05).Knee flexion and extension stability: there was no significant difference in the stability of the knee joint between the anatomical group and the fixed group at the extension position and the 90° flexion position before and after surgery.There was no significant difference in the stability of the knee joint between the anatomical group and the fixed group at the extension position and the 90° flexion position before and after operation.The Hospital for Special Surgery(HSS)score in New York was used: the HSS score in both groups was significantly higher than that before operation.The HSS scores of the anatomic group(75.2±1.48)and the fixed group(74.90±3.58)at 2 weeks after operation,and the anatomic group(81.70±1.53)and the fixed group(82.36±1.99)at 6 weeks after operation were similar,and the difference was not statistically significant(P > 0.05).At 3months after operation,anatomical group(85.07±1.64)and fixed group(83.63±1.92),at 6months after operation,anatomical group(86.80±2.06)and fixed group(85.50±2.01),and at 1 year after operation,anatomical group(87.40±0.97)and fixed group(86.30±1.62),respectively.The above data showed that the HSS score of the knee joint in the anatomical group was higher than that in the fixed group,and the difference between the two groups was statistically significant(P < 0.05).Patient satisfaction score SF-36 score: Postoperative patient satisfaction score SF-36 score was significantly improved compared with preoperative score in both groups;At 2weeks after operation,the SF-36 scores of the anatomic group(53.33±4.44)and the fixed group(54.13±4.45)were close to those of the anatomic group(59.43±3.67)and the fixed group(57.63±4.16)at 6 weeks after operation,and the difference was not statistically significant(P > 0.05).At 3 months after operation,anatomical group(66.53±3.81)and fixed group(64.23±4.91),at 6 months after operation,anatomical group(71.10±4.14)and fixed group(68.97±3.54),and at 1 year after operation,anatomical group(72.20±4.94)and fixed group(69.33±3.89),respectively.The above data showed that the postoperative SF-36 score of the anatomical group was higher than that of the fixed group,and the difference between the two groups was statistically significant(P < 0.05).ConclusionEffect of tibial plateau posterior inclination Angle in total knee arthroplasty with different osteotomy protocols. |
PDF Full Text Request